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Arthritis Rheumatol. 2016 Jun;68(6):1522-30. doi: 10.1002/art.39667.

Infliximab Versus Adalimumab in the Treatment of Refractory Inflammatory Uveitis: A Multicenter Study From the French Uveitis Network.

Author information

1
Hôpital Pitié-Salpêtrière, AP-HP, Centre National de Référence Maladies Systémiques et Autoimmunes Rares, and Université Paris VI, Paris, France.
2
Hôpital Croix Rousse, Lyon, France.
3
Hôpital Saint Louis and Le Centre de Recherche INSERM, Paris Sorbonne Cité, UMR 1153, Paris, France.
4
Hôpital Jean Verdier, Bondy, France.
5
Centre Hospitalier Universitaire (CHU) de Dijon, Dijon, France.
6
Hôpital Edouard Herriot, Lyon, France.
7
CHU de Caen, Caen, France.
8
Hôpital Avicenne, Bobigny, France.
9
CHU de Grenoble-Hôpital Michallon, Grenoble, France.
10
Hôpital Lariboisière, AP-HP, Paris, France.
11
CHU de Rennes, Rennes, France.
12
CHU de Rouen, Rouen, France.
13
Eric Hachulla, MD, PhD: Centre Hospitalier Régional Universitaire de Lille, Lille, France.
14
Hôpital Saint Antoine, AP-HP, Paris, France.
15
A. Rothschild Foundation, Paris, France.
16
CHU de Montpellier, Montpellier, France.
17
CHU de Toulouse-Hôpital Purpan, INSERM UMR 1027, Toulouse, France.
18
Hôpital Pitié-Salpêtrière, AP-HP, Paris, France.

Abstract

OBJECTIVE:

To analyze the factors associated with response to anti-tumor necrosis factor (anti-TNF) treatment and compare the efficacy and safety of infliximab (IFX) and adalimumab (ADA) in patients with refractory noninfectious uveitis.

METHODS:

This was a multicenter observational study of 160 patients (39% men and 61% women; median age 31 years [interquartile range 21-42]) with uveitis that had been refractory to other therapies, who were treated with anti-TNF (IFX 5 mg/kg at weeks 0, 2, 6, and then every 5-6 weeks [n = 98] or ADA 40 mg every 2 weeks [n = 62]). Factors associated with complete response were assessed by multivariate analysis. Efficacy and safety of IFX versus ADA were compared using a propensity score approach with baseline characteristics taken into account. Subdistribution hazard ratios (SHRs) and 95% confidence intervals (95% CIs) were calculated.

RESULTS:

The main etiologies of uveitis included Behçet's disease (BD) (36%), juvenile idiopathic arthritis (22%), spondyloarthropathy (10%), and sarcoidosis (6%). The overall response rate at 6 and 12 months was 87% (26% with complete response) and 93% (28% with complete response), respectively. The median time to complete response was 2 months. In multivariate analysis, BD and occurrence of >5 uveitis flares before anti-TNF initiation were associated with complete response to anti-TNF (SHR 2.52 [95% CI 1.35-4.71], P = 0.004 and SHR 1.97 [95% CI 1.02-3.84], P = 0.045, respectively). Side effects were reported in 28% of patients, including serious adverse events in 13%. IFX and ADA did not differ significantly in terms of occurrence of complete response (SHR 0.65 [95% CI 0.25-1.71], P = 0.39), serious side effects (SHR 0.22 [95% CI 0.04-1.25], P = 0.089), or event-free survival (SHR 0.55 [95% CI 0.28-1.08], P = 0.083).

CONCLUSION:

Anti-TNF treatment is highly effective in refractory inflammatory uveitis. BD is associated with increased odds of response. IFX and ADA appear to be equivalent in terms of efficacy.

PMID:
27015607
DOI:
10.1002/art.39667
[Indexed for MEDLINE]
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